Welcome to the overwhelming 88th edition!
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
- Movin’ Meat asks the tough question: ” how do we, as doctors, deal with the emotional baggage we encounter in our profession?” He then goes into an indepth, thought provoking look at the fact that you are (Only) human. Brilliant writing and discussion on the topic, making it the ripper of the week.
The LITFL Review Top Picks
- Tranexamic acid saves lives, reduces transfusions. So why does no one use it? Because its cheap and off patent is my guess! If it was a brand new drug on the market everyone would be getting it!!!!
- Perimortem Caesarean Delivery: Late is Better than Not – The earlier you have a crack the better, but just having a crack can sometime deliver!
- What happened to HIFU? – HIFU was hailed as the ‘surgery of the future’ a few years ago. As it’s now the future, where is it?
- Targeted ICP reduction in TBI – For patients with severe traumatic brain injury, care focused on maintaining monitored intracranial pressure at 20 mm Hg or less was not shown to be superior to care based on imaging and clinical examination
- Amal shares a case from Dr Sean Fox on why we should check an ECG on every post seizure patient:
- Next Up – Apixaban! Not another anticoagulant on the market I hear you say!
- More C-Spine “Doom and Gloom” Bottom line: These injuries are quite rare, and not every patient needs an MRI or dynamic testing for cervical stability. However, in the end, these tests have a role and should be utilized as necessary in the appropriate clinical situation.
- Left Lower Quadrant Pain – finding the classic features of abscesses on CT scans.
- EMCrit Wee – MOPETT Trial – Should we be thrombolysing our big PE’s? Well yes it would seem…. based on this study!
- Great podcast on Oxygen Physiology with Daniel Davis – when the pulse oximeter is and isn’t your friend!
- Want to dominate the resus room? But not sure what to read? Start here then…. Literature for the Resuscitationist
Academic Life in Emergency Medicine
- Trick of the Trade: Speed up ECG paper rate to differentiate tachycardias – Great trick, hardest part is figuring out how to do it on the ECG machine!
- To debrief or not? Do you know how to facilitate a debriefing session? This post gives you some pointers.
- This week’s PV card i ons Metacarpal fractures, excellent summary be sure to print it out and hang it in your minor injuries room.
- Acute alcohol intoxication and fluid – Who routinely gives fluids to your alcohol intoxicated patients? We know it doesn’t speed up the elimination of alcohol from the system, but it does allow us to replaced the fluid that the alcohol induce diuresis causes, and allows for thiamine administration!
- hard & soft… signs in detecting peripheral vascular injury. Another great review from Chris.
- Calling all nurses, Ian wants you all to start hanging out with you on Google +. So sign up today…..Nurse+ a call for first followers.
- Case report: cocaine cardiotoxicity treated with intravenous lipid infusion – Not sure about this one Leon….Anyone else seen a benefit of using intralipid in the cocaine intoxicated patient?
- CPC: alcohol withdrawal with delirium tremens and a significant missed diagnosis – The lesson: if a patient is delirious, comatose, or otherwise can’t give an adequate history, do a complete exam and investigate significant abnormalities.
- Spinal Dogma Part 3 – Would you clear the c-spine in an intubated patient if you had a normal CT neck? If you do it seems you will miss an c-spine injury once very 14 years. A risk worth taken I believe considering the benefits of of clearing the spine in this patient population.
- David gives a great vodcast presentation on were we are at when it comes to Trauma Resuscitation – An Update for 2012
- Are we drowning our patients? David has a look at the evidence and fallacies for fluid resuscitation in our critically unwell patients. Great piece of writing here, worth having a gander at!
- Nurse to the rescue Drip Drop… Setting up and infusion/drip without a pump!
- A guide to anaphylaxis for our pre-hospital providers! Remember adrenaline is the drug of choice, give it IM and into the thigh.
- Time to challenge the dogma Minor Chest Trauma and Delayed Onset Pneumonia – Take home point from this study: delayed onset pneumonia is uncommon in patients with minor chest trauma.
- STEMI: Which coronary artery is occluded? – Its a tricky one that changes and evolves over time!
- Ibuprofen & Codeine for Pain Management in Children – Bottom line codeine isn’t the greatest drug to be using in our paediatric patients!
- Michelle Lin shares her thoughts on Twitter: The Digital Watercooler. It seems the web’s favorite micro-blogging platform has now proven to be a robust way to keep up with EM literature…Don’t think many FOAMers would disagree with that statement!
- Podcast number 4 is on Labour ward pearls with Dr Shannon – Casey sits down and discusses the basics of birth, labour and the tricky decisions that we need to make at the moment of birth. Excellent pure FOAM!
- Broome Docs Podcast 003: Suicide with Minh as the boys discuss 3 cases of suicidal patients, and share some pearls and pitfalls along the way!
- Practical Tip: Evaluation of Hematuria in Blunt Trauma – In trauma, we only care about gross hematuria, which ranges from the faintest of pink to the deepest red.
- Dr DuCanto on why we need to train – to stay sharp and on top of our game…Basically!
- Brilliant review from Lauren on Black Boxed? Droperidol as an Anti-emetic – also check out her awesome slides and presentation she gave on the topic!
Intensive Care Network
- Semantic sMatter #7 – WTF is Maddrey Discrimination Factor, you ask?
- Nitrous Oxide – Remember its not just for dentist, great review on its many uses in the paediatric emergency population. Have you got it ready for your next procedure in the ED?
- Colin and the team are back to answer the bread and butter questions around UTI in children! Why is Urinary Tract Infection in children different from cystitis or pyelonephritis in adults? How hard should we be looking for UTI, and what’s the best way to confirm or exclude the diagnosis?
- The new oral anticoagulants – the good news – or is it? Are you prepared for the flood of new anticoagulants about to hit your ED!
- Blunderbuss antibiotics in sepsis?? Have to agree that we need a further RCT on empirical broad vs montherapy in severe sepsis. Until then, best to stick to aggressive and targeted abx therapy, as dictated by local resistance and pathogenic patterns. This is often combo therapy, especially for intrabdominal source.
Eric Ling gives us the low down on the power of gravity and how it affects our patients!
The LITFL Review Shout Out of the Week
Shout out this week goes to boringem, a new blog that aims to teach us the non sexy stuff that is the bread and butter of what we do every day. For more on this concept check out: I’m drowning in FOAMed!
- First post of the mark is Urinalysis Voodoo – do you really know how to interpret a UA?
Twee Dee and Twitical Care
News from the Fastlane
- Peter Alley gets involved in and helps launch a New Dutch Emergency Medicine Blog.
- Another great wrap up is available from EMA December 2012… Worth a read!
- Are you sitting on the fence when it comes to stroke thrombolyisis? Michelle tackles the controversies in Schrödinger’s Fence, an excellent piece on something that we are all being confronted with at present. Check out the comments for an even more in-depth discussion.
- Mike and Chris are featured in an article on CNET discussing LITFL and the upcoming SMACC conference…Check out The Best Medicine for more!
- #FOAMed Facts – Mike does the stats on were we are at when it comes to FOAMed.
The Final Words
“You can avoid reality, but you cannot avoid the consequences of avoiding reality.”
– Ayn Rand
LITFL Review EM/CC Educational Social Media Round Up
123Sonography.com — Academic Life in Emergency Medicine — Adventure Medicine— A Life at Risk — All LA Conference — Al Sacchetti’s Youtube — Bedside Ultrasound — Better in Emergency Medicine —boringem—Broome Docs — CCM-L.org — — Critical Care Perspectives in EM — Dave on Airways —DrGDH — Dr Smith’s ECG Blog — ECG Academy — ECG Guru — ECG of the Week—ED Exam —ED-Nurse— EDTCC — EKG Videos — EM Basic — EM Core Content — EMCrit — Emergency Medical Abstracts —EMERJENCYWEBB –EmergencyLondon — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Tutorials—Emergency Medicine Updates —Emergucate —EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMProcedures — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — EM REMS — ER CAST — EXPENSIVECARE — Free Emergency Medicine Talks — GMEP — Gmergency! — Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network — iTeachEM — keepcaring — Keeping Up With Emergency Medicine — KeeWeeDoc — KI Docs — LipheLongLurnERdok — MDaware — MD+ CALC — MedEDMasters — Medical Education Videos — Medicina d’urgenza — Medicine for the Outdoors — Micrognome — Movin’ Meat — Neurointensive Care — Pediatric EM Morsels — PEM ED — PEMLit —PEMTweets Blog — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — Resus.com.au — Resus.ME — — Richard Winters’ Physician Leadership —ruralflyingdoc — SCANCRIT — SCCM Blogs — SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SOCMOB — SonoSpot — StEmylns — Takeokun — thebluntdissection—The Central Line — The Ember Project —The Emergency Medicine Resident Blog — The NNT — The Poison Review — The Sharp End — The Short Coat —The Skeptics Guide to Emergency Medicine — The Sono Cave – The Trauma Professional’s Blog — underneathEM.com — ToxTalk — TJdogma — Twin Cities Toxicology — Ultrarounds — UMEM Educational Pearls —Ultrasound Podcast — Ultrasound Village